S0602 Patient Comorbidities Are Important Predictors of 30-Day Readmission in Patients With Non-Variceal Upper Gastrointestinal Bleeding: Insights From a Nationwide Analysis

Abstract

INTRODUCTION: Non-Variceal Upper Gastrointestinal Bleeding (NVUGIB) is one of the most common gastrointestinal emergencies in the US, with an estimated 300,000 admissions annually and more than $2 billion dollars in associated cost. Early readmissions add to the clinical and economic burden on the healthcare system. Strategies to reduce readmission are now a crucial aspect of management. Therefore, we conducted this study to investigate the outcomes and predictors of 30-day readmission in patients with NVUGIB. METHODS: We queried the 2017 Nationwide Readmission Database (NRD) using ICD-10-CM diagnosis codes to identify (A) all adult patients admitted with a primary diagnosis of NVUGIB (B) all adult patients with primary diagnosis of hematemesis or melena. Patients were excluded if they had a concurrent diagnosis of liver cirrhosis. Outcomes assessed were 30-day readmission rates, mortality, Length of Stay (LOS) and hospitalization costs. A multivariate cox regression was done to obtain Hazard Ratio (HR) and identify independent predictors of readmission. Statistical analysis was performed using STATA software. RESULTS: A total of 304,576 adult patients were admitted with a diagnosis of NVUGIB in 2017, with in-hospital mortality rate of 2.28%. Of the patients discharged, 16.84% patients were readmitted within 30-days. The most common primary diagnosis at readmission was “Sepsis, unspecified organism” (6.61%). When compared to index admission, readmitted patients had higher in-hospital mortality (5.03% vs 2.28%, P < 0.01), increased mean LOS (5.8 days vs 4.2 days, P < 0.01) and higher mean hospitalization charges ( $64,061 vs $46,441, P < 0.01). Readmission added 294,266 inpatient days and $764 million in hospitalization cost to the healthcare burden. Higher Charlson comorbidity score (HR 1.09, P < 0.01), discharge other than home discharge (HR 1.44, P < 0.01), End Stage Renal Disease (ESRD) (HR 1.48, P < 0.01), Chronic Kidney Disease (CKD) (HR 1.25, P < 0.01), CHF (HR 1.36, P < 0.01), Diabetes mellitus (HR 1.16, P < 0.01) and Acute Kidney Injury (AKI) (HR 1.09, P < 0.01) were independent predictors of readmission. CONCLUSION: In the US, about 17% patients with NVUGIB are readmitted within 30-days of discharge, and it is associated with increased in-hospital mortality, LOS, and costs. Our study is the first to demonstrate association of patient comorbidities with 30-day readmission in patients with NVUGIB. Further prospective studies are needed to address early readmission in NVUGIB and improve value-based care.Figure 1.: Graph demonstrating 30-day readmission in patients with NVUGIB.